Training activity information
Details
Perform and interpret colour fundus imaging including red free analysis for patients
Type
Entrustable training activity (ETA)
Evidence requirements
Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion.
Reflection at multiple timepoints on the trainee learning journey for this activity.
Reflective practice guidance
The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.
Before action
- What does success look like?
- Identify what is expected of you in relation to this specific activity, considering learning outcomes related to performing and interpreting a range of ophthalmic imaging modalities, combining information from electrophysiological and imaging findings to inform a diagnosis, employing effective communication, modifying and adapting protocols dependent on patients’ needs, and assessing and managing risks in the testing environment.
- What does successfully performing colour fundus imaging look like, including patient positioning, achieving good focus and illumination, capturing the desired fields of view, and ensuring images are of diagnostic quality? What does interpreting these images and performing red-free analysis involve?
- Discuss with your training officer to gain clarity on what is expected of you when performing and interpreting colour fundus imaging.
- What is your prior experience of this activity?
- Think about what you already know about fundus photography techniques, focusing and alignment, capturing different retinal fields (e.g., macula, disc, periphery), and the appearance of normal retina in colour images.
- Consider possible challenges you might face during the procedure, such as small pupils, media opacities, patient blinking, artefacts (e.g., dust spots, reflections), or capturing peripheral views, and think about how you might handle them.
- Recognise the scope of your own practice for this activity, i.e., know when you will need to seek advice or help, and from whom, regarding difficult patients, complex pathology requiring specific views, or interpreting subtle findings.
- Acknowledge how you feel about performing and interpreting colour fundus imaging including red free analysis.
- What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop in mastering fundus photography techniques, optimising image quality, systematically capturing standard and relevant fields, and effectively performing red-free analysis to highlight specific structures – drawing upon previous experiences.
- Identify specific insights you hope to gain regarding the optimal technique for different patient eyes, the relationship between image quality and diagnostic value, or how red-free images reveal specific types of pathology.
- What additional considerations do you need to make?
- Consult actions identified following previous experience with fundus photography or visualising the retina, if any.
- Identify important information you need to consider before embarking on the activity, such as the reason for imaging, whether specific pathology needs to be documented, potential need for dilation, and any patient factors that might affect image acquisition.
In action
- Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate while performing and interpreting colour fundus imaging including red free analysis?
- Are you encountering situations such as small pupil size or severe media opacities significantly restricting the field of view, or difficulty achieving the necessary contrast or detail when attempting red-free analysis for specific pathology?
- How is this experience comparing with previous experiences of similar activities, like performing other types of fundus imaging?
- How are you reacting to the unexpected development?
- Identify how this is impacting your actions during colour fundus imaging and interpretation. Are you responding to the situation appropriately? Are you adapting or changing your approach? Is it affecting your ability to undertake the activity independently?
- In the moment, what steps are you taking, such as immediately adjusting the illumination or focusing controls to overcome media opacity, or switching techniques (e.g., using different fields) to try and capture the required peripheral views?
- How are you feeling in that moment? Is the technical challenge of achieving a high-quality image affecting your confidence in the resulting diagnosis?
- What is the conclusion or outcome?
- Identify how are you working within your scope of practice when performing and interpreting colour fundus imaging including red free analysis e.g., are you documenting the limitations in view caused by media opacity rather than attempting an unsafe procedure?
- Identify what are you learning as a result of the unexpected development e.g., mastering the use of specific filters to reduce reflections or improve red-free detail?
On action
- What happened?
- Begin by summarising the key points of the experience of performing and interpreting colour fundus imaging and red free analysis.
- Consider specific events, actions, or interactions that felt important during the procedure, such as achieving clear focus/illumination, capturing peripheral views, or successfully highlighting structures using red-free filtering.
- Include any ‘reflect-in-action’ moments, where you had to adapt to the situation as it unfolded, for instance, instantly adjusting illumination to manage reflections or quickly changing fields to capture a difficult view. How did you feel during this experience?
- How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding fundus imaging and red free analysis.
- What strengths did you demonstrate (e.g., technical skill in photography, ability to capture wide fields)?
- What skills and/or knowledge gaps were evident (e.g., difficulty achieving optimal focus in challenging eyes, unfamiliarity with using red-free to assess specific features)?
- Compare this experience against previous fundus photography activities. Were any previously identified actions for development achieved? Has your practice in obtaining high-quality colour images improved?
- Identify any challenges you experienced during the procedure (e.g., small pupils, persistent reflections, poor patient fixation) and how you reacted to these. Did this affect your ability to deal with the situation? Were you able to overcome the challenges?
- Identify anything significant about the activity, such as needing to seek advice or clarification on imaging technique for a specific pathology or escalating due to difficulty capturing sufficient fields of view.
- Acknowledge any changes in your own feelings now you are looking back on the experience.
- What will you take from the experience moving forward?
- Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt, including from any feedback you have received about your ability to perform and interpret colour fundus imaging without direct supervision.
- What will you do differently next time you perform colour fundus imaging? Has anything changed in terms of what you would do if you were faced with a similar situation again?
- Do you need to practise any aspect of the activity further? E.g., Practising alignment techniques for difficult eyes or refining the systematic process of field capture.
Beyond action
- Have you revisited the experiences?
- Have you reviewed the actions identified in your previous reflections for performing and interpreting colour fundus imaging including red free analysis? What specific actions did you previously identify you would need to take to improve your practice, such as refining your fundus imaging technique, improving your red free analysis skills, or becoming better at identifying artefacts?
- Have you completed these previously identified actions? If so, how did completing them impact your subsequent performance of this activity?
- Are you ready to demonstrate this new learning confidently and consistently when performing and interpreting colour fundus imaging?
- Engage in professional storytelling about techniques for achieving high-quality colour fundus images in challenging patients (e.g., small pupils) and the difficulties of interpreting subtle pathology using red free analysis with peers, near peers, or colleagues. Has discussing these experiences changed your perspective or approach?
- How have these experiences impacted upon current practice?
- Consider how the accumulated learning from performing or reflecting on performing and interpreting colour fundus imaging will support you in preparing for relevant observed ‘in-person’ assessments for the module. This includes DOPS like ‘Set up a patient and perform colour fundus imaging’ or ‘Assess an image for artefacts,’ or Case-Based Discussions. This relates to demonstrating your ability to perform and interpret fundus imaging and critically evaluating images.
- How has your practice related to performing and interpreting colour fundus imaging developed and evolved over time? This includes recognising when something related to this activity is beyond your scope of practice, such as when fundus findings are unclear or require specialist interpretation.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 2 |
Outcome
Perform and interpret a range of ophthalmic imaging modalities. |
| # 3 |
Outcome
Combine information from electrophysiological and imaging findings to inform a diagnosis. |
| # 4 |
Outcome
Employ effective communication with a range of individuals including the patient and the multidisciplinary team. |
| # 6 |
Outcome
Modify and adapt protocols dependent on patients’ needs. |
| # 7 |
Outcome
Assess and manage risks in the testing environment. |